Don't wait for patient to ask about costs —

Tell them upfront

Point-of-service collections at Advocate Illinois Masonic Medical Center in Chicago have increased by 294% since an electronic payment estimation tool was implemented in 2008, reports Philip N. Quick, CHAM, manager of patient access and bed management.

Registrars don't wait for patients to ask about their out-of-pocket expense; instead, they tell them upfront, he says.

"At the point of scheduling for any outpatient service, if the patient does not inquire about estimated price for their service, we'll automatically provide it to them, in addition to the estimated out-of pocket expense they may be responsible for," says Quick.

With this step, there are no surprises, either at the time of service or when the patient receives the statement, says Quick. "Chicago is well known for its competitive healthcare market. We put tools and processes in place early on, prior to healthcare reform," he adds. "We've been proactive in anticipating the shift in healthcare." Here is the department's current process:

• At the point of scheduling, patients are preregistered and given an estimate of what the service will cost.

• This information is supplied to the patient, and payment options are discussed to avoid surprises at the time of service. "For walk-in patients and stat add-on procedures, the process is the same, performed at the time of registration," says Quick.

Estimates expanded

Price estimates previously were given only for outpatient services at Advocate Illinois Masonic Medical Center, but now they are given to emergency department patients and inpatients.

"We wanted to be consistent with our financial advocacy efforts throughout the organization and not limit it to outpatients," Quick explains. "Aside from the upfront revenue opportunity in these areas, we knew that patients in all areas needed to be educated about any financial responsibility as early as possible in their experience."

The goal is for the patient to have no surprises, regardless of where he or she is receiving treatment, emphasizes Quick. The emergency department and inpatient services can be difficult to determine, however, because all charges haven't been accounted for at the time the registrar is running an estimate. "In the ED, having set level charges can get to more of a granular level of patient responsibility when running an estimate. But it still won't be 100% accurate," says Quick. It's extremely important to communicate to the patient that he or she is being given an estimate in all scenarios, he underscores.

"Without the correct tool or process, you run the risk of not only over- or underpayments from the patient, but also negative patient and staff satisfaction," says Quick.

The more information registrars can communicate to a patient upfront, the better equipped that patient will be to make decisions, adds Quick. "In the changing healthcare environment, where increasing onus is being placed on patients, patient access needs to be equipped to meet their needs," he says.


For more information on informing patients of their out-of-pocket responsibility, contact:

• Philip N. Quick, CHAM, Manager, Patient Access & Bed Management, Advocate Illinois Masonic Medical Center, Chicago. Phone: (773) 296-8303. Fax: (773) 296-8119. Email: